Provider Demographics
NPI:1114430048
Name:DEMARSH, DOMINIQUE SIMONE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DOMINIQUE
Middle Name:SIMONE
Last Name:DEMARSH
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DOMINIQUE
Other - Middle Name:SIMONE
Other - Last Name:DESHANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 ALLEN PL
Mailing Address - Street 2:
Mailing Address - City:SCITUATE
Mailing Address - State:MA
Mailing Address - Zip Code:02066-1301
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:234 COPELAND ST FL 3
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-4082
Practice Address - Country:US
Practice Address - Phone:781-386-7141
Practice Address - Fax:617-479-4798
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1135051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical